Physical Examination.docx

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School

University of Calgary

Department

Nursing

Course

NURS 287

Professor

Rick Nilson

Semester

Winter

Description

Physical Examination
When conducting a health assessment of the cardiovascular system, a thorough physical
examination should include the following:
 General appearance, vital signs, including orthostatic (postural) BPs and HRs
 Inspection of the skin, extremities, and the large veins of the neck
 Bilateral and simultaneous palpation of the upper and lower extremities
 Bilateral and simultaneous palpation of the pulses in the extremities
 Capillary refill
 Auscultation of carotid arteries, abdominal aorta, and femoral arteries
 Inspection and palpation of the thorax, epigastric area, and mitral valve area
 Auscultation of the heart with the bell and diaphragm of the stethoscope
 Auscultation for extra heart sounds (S3or S4) with the bell of the stethoscope
DIAGNOSTIC STUDIES
The most common procedures used to diagnose cardiovascular disease include the following:
 Blood studies
o Creatine kinase (CK)-MB: levels increase with myocardial infarction (MI)
o Cardiac-specific troponin: levels rise with myocardial injury
o Myoglobin: sensitive indicator of early myocardial injury
o Serum lipoproteins: including triglycerides, cholesterol, and phospholipids
o C-reactive protein (CRP): emerging as an independent risk factor for CAD and a
predictor of cardiac events
o Homocysteine (Hcy): elevated levels have been linked to an increased risk of a
first cardiac event and should be measured in patients with a familial
predisposition for early cardiovascular disease
o Cardiac natriuretic peptide markers: emerged as the marker of choice for
distinguishing a cardiac or respiratory cause of dyspnea
 Chest x-ray
 Electrocardiogram
o Deviations from the normal sinus rhythm can indicate abnormalities in heart
function.
o Continuous ambulatory ECG (Holter monitoring): recorder is worn for 24 to 48
hours, and the resulting ECG information is then stored until it is played back for
printing and evaluation. o Transtelephonic event recorders: portable monitor uses electrodes to transmit a
limited ECG over the phone to a receiving device.
 Exercise or stress testing
o Used to evaluate the cardiovascular response to physical stress
 6-Minute walk test
o Used for patients with heart or peripheral arterial disease to measure response to
medical interventions and determine functional capacity for daily physical
activities
 Echocardiogram
o Uses ultrasound waves to record the movement of the structures of the heart.
o Provides information about (1) valvular structure and motion, (2) cardiac chamber
size and contents, (3) ventricular muscle and septal motion and thickness, (4)
pericardial sac, (5) ascending aorta, and (6) ejection fraction (EF) (percentage of
end-diastolic blood volume that is ejected during systole).
 Nuclear cardiology
o Multigated acquisition (MUGA) or ca